Going Home: Low-Income Elders Can Live Full Lives

(Part 2 of 2)

Drs. Gayle Hersch and Jean Spencer of the Texas Woman's University School of Occupational Therapy have received two grants to study transitional care services and the elderly, particularly those older adults in a low-income bracket, and what happens when these elders return home. Part 1 discussed the first study, "Outcomes of Protocol-Based and Adaptation-Based Occupational Therapy Interventions for Low-Income Elders on a Transitional Unit."

After the elders were discharged, information on their daily lives was gathered through interviews with both the subjects and their family members. In the end, Drs. Hersch and Spencer found that about half of the participants relocated to new living arrangements after they were discharged from the transitional unit. Also, 91 percent of the protocol-based goals and all of the adaptation-based goals had been met in some fashion, with some modification in the goal or development of new solutions.

In addition, they found that elders valued returning to former occupations and relationships. For family members, getting quality care for their elders mattered most, while therapists most valued improvements and increases in strength, endurance and independence.

Moving in New Directions

The second initial study, titled "Continuity of Functional Outcomes for Minority Elders," began with 25 African- American elders, but wound up tracking 17, as a result of either relocation or death. In this six-month study, participants were contacted in their homes following a period of hospitalization in an effort to track their functional outcomes.

Five to six interviews were conducted with each elder to determine whether or not they continued to be involved in the activities and social relationships they sought to maintain while they were in a transitional unit. Activities of daily living (ADL) were also monitored, as were any health incidents that may have caused a change in their way of living.

Drs. Hersch and Spencer eventually found that the majority of the elders remained either in their own homes or in a similar home setting with support from family members and that most of them returned to their daily activities as best they could, based on their own situation.

"We found that family support, ability to perform self-care and being involved in activities most affected their functional outcomes in this study," Dr. Hersch says. "We also found that their sense of resiliency or coherence played a big part in their outcomes. Their faith was strong, and that really seemed to keep them going."

Dr. Spencer notes that a strong sense of resiliency, as well as support from friends and neighbors, can make all the difference for an elder attempting to return to a certain way of life after a stay in the hospital.

"Some of these elders were really quite extraordinary, and I think that kind of resilience has a lot to do with that," she says. "There was one man who, when we first saw him, had been in the hospital to have one of his legs amputated. In later studies, we found that he went home to live with his diabetic sister and that he continued to go out with his buddies to listen to music - they just loaded his wheelchair into their van.

"In follow-ups, we learned that his sister had died and that he had to have his other leg amputated, yet he's now back home again and still active. He has a neighbor come in to help him with his meals, but he still bathes and dresses himself, and his buddies still are willing to load the wheelchair and take him out. I think he's a nice example of a person who is very resilient and is able to use informal things like neighbors and friends to help him get on with his life."

The Road Ahead

In the fall of 1998, Drs. Hersch and Spencer began two new studies, both of which should be completed by the end of next summer. The first, "Adaptation to Community Relocation by Elders," is funded by a $30,000 extra-mural research associate award (EARDA) grant. The other project, an ethnography study titled "Residential Settings Used by Low-Income Elders," is supported by a $6,000 award from the TWU office of research and grants.

Dr. Hersch says both were inspired by specific results of their previous research which showed that adjustments need to be made in the health care system for elders who are returning to the community - from clinical personnel who prepare elders for going home, to the reimbursement system for health care professionals, to the attitude that at-home health care is more cost-effective than nursing homes.

And that's not all, Dr. Hersch declares.

"What's most important is that we realize how resilient elders are and how strong their adaptive capacity really is," she says. "We don't often give them credit for that, but it's time we started."

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©2006 Texas Medical Center

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